Sunday, April 01, 2007

HIV in Victoria, and passing the buck/bug

Fact: Epidemics increase exponentially until the broader population has been decimated. The only circuit-breaker that can work against this natural law is the effective quarantining of the already-infected from the broader population.

In Australia, unlike most of the rest of the world, there has long been a de facto quarantining, albeit with a twist. Already-infected gay men – always the major sub-group among the already-HIV+ population of Australia – were in the 1980s placed in more or less the same boat as gay men generally. That is, the quarantine was relatively indiscriminate in placing already-infected alongside uninfected gay men behind its “walls”.

Twenty-three or so years later, the results of this odd quarantining strategy are predictable. For a reasonable period, HIV appeared to be on the wane as an epidemic, both among gay men and the general population. Then a secondary epidemic emerged, of course, from behind the quarantine’s “walls”. Gay men of my generation (born 1963-1976) have been disproportionately affected by this secondary epidemic.

I am angry about this because it was so predictable. A “soft” quarantining of the already-infected in the mid-1980s – disproportionately baby boomers – was either expedient and short-term, or coldly calculating. With all gay men deemed to be behind the walls, a deliberately fudged, de-medicalised and de-legalised discourse took off. Gay boomer-dominated state AIDS Councils waxed on how, working from the inside, they were best able to introduce “behaviour change” among gay men; i.e. to enforce (although I doubt that is a word they ever would have used) safe sex among gay men.

Well guess what? The quarantining of all gay men, as a self-contained jurisdiction with its own warm and fuzzy rules, was not able to conquer the natural law of epidemiology, which dictates that the primary object of quarantining must be the distancing of the already-infected from the broader population. Any other form quarantining will simply breed a secondary epidemic – i.e. it will be perversely set up an identifiable class of “to be infecteds”. And Xer gay men were the patsies in this criminally dumb experiment.

I am not suggesting actual physical quarantining of Australia’s already-HIV+ population generally. Most Xer gay men have known all their adult life that the buck, and hence the bug, stops with them, anyway. Boomer gay men, OTOH, share in their generation’s general amorality and lack of personal responsibility. It is no surprise and no accident that psychopath (alleged) HIV-spreader Michael Neal is a boomer, and most of those he infected are apparently Xers.

Australia’s state AIDS Councils should all be immediately disbanded, and replaced with a system that places far more legal responsibility on, and medico-legal supervision over, the already-HIV+. This would not likely come as a draconian shock to most already-HIV+ Xer gay men, at least. But if boomers need to be locked up indefinitely, so be it.

By enforcing responsibility and supervision, an equal and opposite weight will be lifted from the shoulders of currently uninfected gay men: they will go from being a “to be infected” class to being with who they actually belong among: the uninfected general population.

Is it really true that gay males are still the biggest subgroup of HIV carriers? I thought that intravenous drug users had taken them over (at least in new infections).
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